Chapter 17
ICBS 120
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Usually the responsibility of the medical
assisting staff.
Discussion of Fees
◦ Fees vary depending on type of medical facility,
needs of practice, and the professional services
rendered.
◦ If possible, try and approximate cost of
procedure(s)/treatment for patient.
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Advanced Beneficiary Notice approved by Medicare
should indicate type of procedure(s), the total
responsibility of patient, and the reason why this is
the patient’s responsibility.
Adjustment of Fees
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If an office accepts assignment with Medicare and
Medicaid, they are mandated to charge every patient the
same amount for similar services rendered.
Adjustments may be made for patients experiencing
hardships or with limited income.
Assist with payment planning
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Accounts receivable – money owed to the
office by patients.
◦ Track patient accounts via the “pegboard” system or
“one-write” method.
◦ Always work with care and accuracy
◦ Keep work current
◦ Double check all entries
◦ Use consistent ink color
◦ Align columns carefully
◦ Write small enough to stay within columns
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Pegboard System – consists of day sheets,
ledger cards, encounter forms or charge
slips, and receipt forms.
Posting – entering charges, credits or
adjustments onto the day sheet, encounter
form, or receipt and patient’s ledger card.
◦ Day sheet provides complete up-to-date
information about accounts receivable status.
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Computerized systems
Being used by more and more medical facilities
Several software packages available
May hire consultant
Make sure system will meet current and future
needs of practice.
◦ Adopt a system that allows the practice to start with
one component and add another component at a
later date.
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Encounter form – charge slip, superbill, or
multipurpose billing form.
◦ Use in manual and computerized bookkeeping
systems.
◦ Provides patients one copy with a record of account
activity for the day
◦ Provide a second copy for possible need to submit
to insurance.
◦ Provides third copy that serves as the office’s
permanent copy of account activity.
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Ledger – where patient accounts are recorded
(accounts receivable ledger)
◦ Lists services, payments and balances due.
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Guarantor – the one responsible for payment
of the account.
Debit – used for entering charges, services
and procedure codes.
Credit – used for entering payments.
Balance – record difference between debit and
credit.
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Adjustments
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Indicate any insurance payments
Personal discounts, write-offs
Other adjustments
Indicated by the credit column and will generally
reduce entries.
Day Sheet
◦ All financial transactions posted here daily.
◦ Legibility and accuracy are critical.
◦ Balances carry over day-to-day.
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Receipts
◦ Used for payments on accounts
◦ When patient makes payment on account on day
when no services were rendered.
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Month-End Activities
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Computerized Patient Accounts
◦ Required when last day sheet for month has been
balanced, verify month-end figures to make sure
agree with patient accounts.
◦ Software management programs for patient
accounts; automatically calculates/creates billing
statements.
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Online banking – allows individuals to check
account balances, transfer funds between
accounts, pay bills electronically, check credit
card balances, view images of check and
deposits.
Types of Accounts
◦ Checking – primary type
◦ Savings – may or may not pay interest
◦ Money-Market – pay a higher rate of interest
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Cashiers Check – often used when check
must be guaranteed for amount written.
Certified Check – depositor’s own check that
bank has “certified” with date/signature and
check is “good.”
Money Order – purchased with cash
Voucher Check – check with a stub attached
to indicate dates, services provided.
Traveler’s Checks – safer than cash when
traveling. Written in specific denominations.
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Usually made daily since they serve as
another proof of posting
Unwise to leave large sums of money in the
office overnight
Checks should be stamped immediately upon
receipt
Verify all checks have been endorsed before
depositing them
All deposits should be 100% Accurate
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Inspect for date, amount and signature.
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Do NOT accept a third-party check.
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If a deposited check is returned and marked
“insufficient funds” (NSF), call the bank and
verify availability of funds.
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Accounts payable – refunds of overpayment,
replenish petty cash.
Rules for preparing checks
Confirm numeric and written amounts
Confirm spelling
Follow proper office procedure
Determine check has been signed by proper
authority
◦ Confirm check is payable to correct payee and
current date is used.
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Avoid purchase of unnecessary items.
Avoid duplication of items purchased.
Provide a system for payment of only those
items properly ordered and received.
Nothing is ordered or paid for without a
purchase order or purchase order number.
A copy of the purchase order should be
retained by the office.
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Money kept in the office for minor, routine, or
unexpected expenses.
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Postage due
Coffee supplies
Patients that may pay co-payment with cash
Amount on hand is usually $75 to $100
Be sure to track your petty cash by completing a
receipt
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Inspect the check for the correct date, amount,
and signature
Do not accept a third-party check unless it is
from the insurance carrier
Lost or Stolen Checks
◦ Report Immediately
◦ Stop Payment
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Balance the checking account
Compare cleared checks to uncleared checks
to bank deposits
Compare and balance bank deposits to
month end payment reports
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Financial and ongoing billing records should
not be maintained in the patient’s chart.
Keep financial information separate from
medical information to ensure that the
physician’s care is not influenced by the
patient’s ability to pay